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Home My WebLink About2022-06-02 - Form 410 - JacksonStatem4t of Q;�ganiLation Recipient Committee - Statement Type ❑ Initial Amendment ❑ Termination — See Part 5 i is `° t.4 s '* For Official Use, Only 0 Not yet qualified t, I: IT',OF # Ak L .. I b4,G + or Q Date qualification threshold met Date qualification threshold met Date of termination. J202 o I.D. Number / r a licabre �_ • `� `� NAME OF COMMITTEE �_ Ja Esc Pam- ��,� .= NAME OF TREASURER ,� .f e�,v� I a�"6ey L- �/ f17 rSTREET 1�2 fY1 - ADDRESS (P10 P.O. F105f) STREET ADDRESS (NO P.O. BOX) 1 ` STATE Z1P�CODE AREA CODE/PHONE j YYA C 4 CITY C STATE 23P CODE AREA L`ODEPHOWE (0 NAME 'OF ASSISTAXT my FULL MAILING AJDRESS (IMFFIRENT1 STREET ADDRES (NO P.O. BOX; 1-rc le, E MPIIL ADDRESS (REQUIRED, / FAX (OPTIONAL' _ • V� '. l �l V el r ' • y CITY. STATE ZIP CODE AREA CODE/PHONE �� 1. S1 v r C, A � � V COUNTY OF DOMICILE JURISDICTION W rAr COMMITTEE IS ACTIVE Spy'( NAME OF PRINCIPA OFFICERW \16 e-w Lf STREET ADDRESS W P.O. $O)O N3 Attach additional information on appropriately labeled continuation sheets. CITY STATE. ZIP CODE AREA CODE/PHONE . 1 a S f I have used all reasonable diligence in preparing this statement and to the best of my knowledget a information, contained herein is true and complete. J certify ----- ,und- ---- er penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 7 By DATE SIGNATURE OF TREASU R'OR ASSIS NT TREASURER Executed on 0- By �. DATE 5► .TtIRE OF CONT TAT LUNG OFFICEHOLDER,,CAND E, OR SE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form'410 (August/2018) FPPC Advice: advicePfppc.ca.gov (866/275-3772) ww,fPgC,Ca. ov M Statement of Organization CALIFORNIA Recipient Committee FORM INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME , LD7"Bw q Ta&5 -F? • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION p, n 1� AREACODE/PHONE ::z r -11� BANK ACCOUNT NUMBER 1,5 1,5 5; 7,3 �. ADDRESS CITY STATE ZIP CODE Sk Y- -'Ficble C :4,'Type t s sections.7-,"'..".", f COmmiiqoe' Complete the' abp [�l��r��l�•Tl rIJ![i�� • List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and district. number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check "no.npartisan." Stating "No party preference" is acceptable • . if this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY NAMF OF CANDinATF/OFFICEHOLDER/STATE MEASURE PROPONENT IINr-tunF DISTRICT NUMBER IF APPLICABLE) ELECTION ruFrr nNF • dc 56-n 1 v V V ♦� •. P YI ` - 2b Nonpartisan Partisan (list political party below) Nonpartisan Partisan (list political party below) • - Primarily formed to support or oppose specific candidates or measures in a single. election. list below: CANDIDATE(S) NAME ORWEASURE(S) FULL TITLE.(INCLUDE BALLOT NO. OR LETTER) CANDIOATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR CUUNTY, AS APPLICABLE) CHECK ONE SUPPORT OPPOSE SUPPORT OPPOSE FPPC Form 410 (August/2018) FPPC Advice: advice fppc.ca.gov (866/275-3772) WWW.fl_)pc:ca.gov i""L L Ommittee INSTRUCTIONS ON -REVERSE Y �` COMMITTEE NAME CALIFORNIAFORM41 Vl n ,. Page 3 5 �, j . • V �C, 1 )/ +�^ I.D. NUMIIER Not formed to support or op CITY Committee Pose specific candidates or measures in a single 'ROVIDE BRIEF DESCRIPTION OFACTMTY COUNTY Committee.Check only one box: election. ❑ STATE Committee. List additional sponsors on an +ME OF SPONSOR attachment. ^tEET ADDRESS INDUSTRY GROUP OR AFFIUATgN OF SPOT NO. AND STREET CITY IM, STATE ZIP CODE MMUM . _ AREA CODE/PHONE Date q ua lifted t � ; HI This committee has ceased to receive contributions- _ _ _ and make expenditures, • ' , • - This co mmittee does not anticipate receiving contributions or making expenditures in t This committee has eliminate he futur eliminated.or has no intention or ability to discharge-future; This committee has no surplus f all debts, loans received P funds; and ,and other obligations; This committee has filed all state campaign'ui, statements required by the Political Refo There are restrictions on the disposition of Att disclosing all re Government Code Section g surplus campaign funds Portable transactions. " 9519. held by elected officers who are leavingo Leftover funds of ballot measure committees f ice and by defeated candid 89518, and are subject to Elections Code Se ates. Refer to ees may be used for political legislative or governmental Section 186- and FPPC Regulation 18521.5 mmental purposes under Government Code Sections 89511 - - FPPC Advice: adviceFP� �� 410 (August/2018) , c.c -, ov {866/275-3772) • ��•fnpC Ca ani.